How can core NHS and care services be supported during the pandemic and beyond?
The scope of our inquiry was to assess the impact and unprecedented challenge caused by COVID-19 to the provision of essential services.
We have focused on key aspects of services, particularly affected by the pandemic:
- Communication issues with patients
- Waiting times and backlog of appointments
- Availability of PPE and routine testing for NHS and care staff
- Staff stress and burnout
- Race and diversity in the NHS
- Lessons learnt for the future to support the NHS
Communication issues with patients
Delay of appointments
Throughout the course of the pandemic, the message from Government and NHS England and Improvement has been that “the NHS is open for business”. However, despite this reassuring message, the reality of accessing health and care services for some has been mixed, causing anxiety and stress.
Some patients with critical needs were unable to find out what medical treatment and advice was available, how to access health services safely and whether their appointments were going ahead.
At one of our hearings we heard from Daloni Carlise, an NHS cancer patient who told us how hard it was for her to cope with the lack of information from the NHS about her chemotherapy treatment.
"I fell into a hole where I was absolutely in limbo. I did not know, and I had no communication about, when the chemotherapy might start. For most of the lockdown I have been sitting here at home knowing that all the cancers are growing [...], and there has been absolutely no word at all from the hospital about when some treatment might start."
Shielding
The message about shielding was also perceived as confusing. We received many written submissions highlighting the difficultly patients have had in understanding shielding guidance and what it means for them.
"General confusion over isolating and shielding. Employers and even GPs not understanding the difference."
Waiting times and backlog of appointments
With the NHS rightly focussing on treating patients with COVID-19 there has been a substantial increase in the number of missed, delayed and cancelled appointments across essential non-COVID related services. We have focused in particular on four of these services: non-urgent surgery, mental health services, cancer treatments and dental treatments.
Surgery
During the pandemic, surgery has been mostly postponed and resources have been reallocated to other areas in order to help tackle COVID-19.
The evidence we have received from health professionals warned us about the consequences of postponing surgery:
"Many patients require surgery in a timely fashion if they are not to suffer from worsening symptoms, deterioration in their condition, greater disability and (in some cases) a significant risk of death."
During our inquiry we also heard from Rob Martinez, an NHS patient who had his operation for joint replacement cancelled. He spoke to us about the devastating effects the cancellation of his surgery had on his physical and mental health:
"I have ongoing pain in my knees. I have difficulty climbing stairs at home, and anywhere else. I have pain when walking and sleeping. I basically have pain all the time. [...] I am frustrated and anxious. My family and social life have been affected as well. It is having an impact on my mental health. It is the not knowing. It is as though my whole life is on hold."
Mental health services
Since the start of the pandemic there has been significant disruption to referral routes (such as schools, primary care and A&E departments) for mental health services. There has also been an important decrease in referral rates to, and a reduction in, patient use of mental health services.
Extra demands on mental health provision were expected as a result of the pandemic. Among evidence received, 80% of people living with severe mental health problems reported their mental health support had been "severely cut" and did not feel supported at all by what was offered.
Sir Simon Stevens, Chief Executive of NHS England and Improvement, told us that he expects extra demands on mental health provision as a result of the pandemic, but described the additional burden as “unknown”.
Cancer services
Cancer Research UK has reported that urgent referrals for diagnostic tests for suspected cancer have dropped by 75% in England, despite national guidelines stating that urgent and essential cancer treatments must continue.
Representatives from NHS England and Improvement care told us that cancer services will have to be delivered in a new, innovative way.
Dental services
Approximately eight million courses of dental treatments in England were cancelled during the pandemic. The Chair of the British Dental Association described the availability of dental services as "virtually non-existent" at that time.
Dental practices in England had been instructed to suspend all routine, non-urgent dental care while NHS regions set up local Urgent Dental Care systems for emergency dental treatment only.
Despite the restoration of dental practices from 8 June 2020, concerns remain about the backlog of appointments for routine dental care.
Personal Protective Equipment (PPE)
and testing for NHS and care staff
Availability of PPE
Evidence received throughout the inquiry demonstrated persistent issues with purchase and supply of appropriate personal protective equipment (PPE) to some NHS and care staff, particularly during the early stages of the pandemic.
We have heard that some NHS and care staff were frustrated by a lack of, or in some cases perceived lack of, access to appropriately fitting PPE. Some members of staff have also expressed a desire to be routinely tested for COVID-19.
The lack of adequate PPE for dental practices also limited the number of patients that received treatment.
Testing
All front-line NHS and care staff are placing themselves at an elevated risk of catching COVID-19. But despite repeated pleas from NHS and care staff and representative organisations, from prominent scientists and from other House of Commons Select Committees, the Government and NHS England and Improvement have not yet introduced routine testing for all asymptomatic NHS staff.
Throughout our inquiry, we have heard that the Government's and NHS England and Improvement's testing strategy has possibly moved too slowly and put patients, care home residents, and NHS and care staff at avoidable risk.
We have also heard that routine testing of NHS staff will be key to restoring public confidence that NHS services are safe to use.
"We cannot build confidence for patients coming into hospitals if we cannot be sure that we can protect everybody. We must make sure [through regular testing] that staff are not carrying the virus, because asymptomatic spread is a worry, and staff-on-staff infection is a worry."
On 30 June 2020, Sir Simon told us that capacity to conduct routine testing remained a problem. He explained:
"The aim, clearly, by the end of September or October [2020] is to have significant extra lab capacity so that, were the Chief Medical Officer then to recommend a change in the asymptomatic staff testing policy, that would be something that could be delivered."
Staff stress and burnout
We have heard that much of the NHS and care staff workforce experienced fatigue, exhaustion and were otherwise “burnt out" due to responding to the pandemic, and that the wellbeing of staff, particularly their mental health, is considered to be at significant risk.
"The workforce is really tired at the moment. [...]That is all parts of the workforce, not just doctors; it is nurses and other healthcare professionals, who are all part of the hospital team [...]. The worry that the peak is going to get higher in winter is a big one."
Our key recommendations
These are our key recommendations to the Government and to NHS England and Improvement:
On communication issues with patients
NHS England and Improvement must prioritise reviewing how they and NHS Trusts communicate with patients about medical treatments and important medical guidance. This will be key ahead of any future spike or second wave.
On waiting times
We ask the Department of Health and Social Care and NHS England for an update on what steps are being taken and what steps will be taken in the future to manage the overall level of demand across health services, by the end of October 2020.
On testing
We accept the advice from many world-leading scientists that there is a significant risk that not testing NHS staff routinely could lead to higher levels of hospital acquired infections in any second spike.
We therefore urge the Government to set out clearly why it is yet to implement weekly testing of all NHS staff.
We ask the Government to update on us on routine testing capacity for all staff by end of October 2020.
On PPE
We ask the Department of Health and Social Care to update us by the end of November 2020 on how they will ensure a consistent and reliable supply of appropriately fitting PPE to all NHS staff in advance of the start of winter and a potential second wave.
On staff stress and burnout
We ask NHS England and Improvement to set out in detail what further specific steps it would like to take over the coming years to support the mental and physical wellbeing of all staff.
We ask NHS England and Improvement to develop a full and comprehensive definition of "workforce burnout" and set out how the wellbeing of all NHS staff is being monitored and assessed by the end of October 2020.
On challenges facing BAME staff
We ask NHS England and Improvement to provide a full and comprehensive definition of the "racism and discrimination" that it seeks to eliminate from the NHS by the end of 2020.
We invite NHS England and Improvement and the Department for Health and Social Care to set out in detail its strategy to tackle racism and discrimination and to promote diversity in the NHS, including information on targets and deadlines.
What's next?
The Government must now respond to our report.
Our report "Delivering core NHS and care Services during the pandemic and beyond" was published on Thursday 1 October 2020.
Detailed information from our inquiry can be found on our website.
If you’re interested in our work, you can find out more on the Health and Social Care Committee website. You can also follow our work on Twitter.
The Health and Social Care Committee is a cross-party committee of MPs that scrutinises the work of the Department of Health and Social Care and its associated public bodies.
Cover image credit: UK Parliament
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